[BohoMama]

OK, I hope you don't mind this being a bit beyond the usual concerns in the MDC fora, but here goes:

I have lived abroad for nearly all of my adult life. However, people often ask me about the U.S. health care system, and particularly about health insurance and the fate of the uninsured. I try to answer their questions as best I can, but my knowledge is very spotty. Some of the things people usually want to know are, how do uninsured people get medical care? What happens if they have a chronic illness? What happens if they started out owning, say, a home and a car after they have lost these to medical payments? Are they hounded even after they have no more assets? Or are their relatives hounded? Which relatives can be considered liable to pay their debts? Do children pay the unresolved medical debts of deceased parents if those parents died with little or no estate to pass on? Can a debtor pass property to a spouse and then get divorced on paper in order not to lose their assets? Do people often declare bankruptcy because of medical debts? Does this also happen to insured people? Do people who have declared bankruptcy and/or lost their jobs and/or their insurance become uninsurable for the rest of their lives? How do uninsured mothers give birth?

Let's not talk about the lousiness of the plight of uninsured people. That is clear enough. Please help me find out where to seek more information or send others to research topics such as these.

Thanks a lot.

 

[workjw]

There is really not a good answer to your questions. A lot of it depends on what state you are in, and what kind of health care system that particular state has set up. In a lot of states, there are systems in place to help care for the uninsured. In my state, any child under 21 has access to some type of health care depending on their health, and the parents income. As for adults, you're pretty much screwed unless you are uninsurable or can get disability from the federal gov't.

I'm not sure of the exact rules, but if you go to the ER, they have to treat you, so there is access to care - it's just incredibly expensive after the fact. There are a lot of wonderful private clinics set up to help the uninsured, but they're not exactly on every corner. As for being uninsurable, our dd is considered "uninsureable" because 2 private insurances have refused to cover her, so she is covered by the state (although we qualify financially as well). That doesn't necessarily = uninsurable for life, a lot of that depends on the condition for which you are being turned down for, and the duration of the condition. There are other options, assuming you can get a job with a company that offers good insurance. It's my understanding that group insurance has to accept you despite medical history.

I personally know 2 people who have lost everything b/c of medical bills, but they were not UN-ininsured, they were UNDER-insured. I have a friend whose mom has cancer. She sold everything she owned to a good friend so that it would not be in her name or a family member's, but in the end she lost it anyway, when she could no longer afford the mortgage. Her treatment is considered outpatient, and therefore is not covered by her insurance. The state won't insure her b/c technically she has insurance.

In a more positive light, any pregnant woman automatically gets insurance from the state until they deliver. The child is automatically covered for 1 year. I was insured when I got pregnant with DD, but pregnancy was considered a pre-existing condition (b/c we had only had the insurance 7 mos). The state automatically picked me up.

It's definitely a broken system all the way around, but some states have better options than others. My state has done a pretty good job of insuring kids, but the system itself is a mess. The state is nearly bankrupt, and there are very few options for anyone over 21, so obviously there is a huge population of uninsured adults - myself included. I can GET insurance, we just can't afford the extra $250 a month. It's really a mixed bag from state to state.

 

[user_name]

you have lots of specific questions, so please forgive me if i feel compelled to respond to an apparent general difference of philosophy...

#1, like the pp said, if you have an emergency, you can't be turned away from an er for lack of insurance or money.

#2 there are a great many more luxuries-considered-necessities these days not only with regard to everyday living (car, electricity, cable, tv, telephone, changes of seasonal clothing, food other than the simplest of staples, etc.) but also with regard to medical care (antibiotics for colds/sore throats (prior to culture no less), medication for chronic high blood pressure (esp for overweight people or smokers), knee replacements (& physical therapy), etc.)
medical professionals are not supposed to judge their patients or take their patients' deservedness (is that a word?) into account. they cannot claim to know a patient's full-story or circumstances, nor can i. that's not what i'm doing -- for every sincerely-sad and terrible story of healthcare woes, the *generality* still applies: people in this country need a great deal less than they think they do.

#3 preventative care is cheaper long-term sometimes, but it's not all it's cracked up to be, and

#4 technology is expensive.

i find difference with people who believe it is immoral or wrong to apply capitalistic principles to healthcare. some would argue capitalism makes for a better healthcare system. no system is perfect; i'm not trying to defend everything about the u.s.'s healthcare or any tragedies it has caused, anecdotal or otherwise. i am, however, a bit irked by the constant insinuation that people somehow have a *right* to the latest and greatest in healthcare. poppycock.
if a doctor is willing to donate her time & expertise, or a clinic or hospital is set-up to provide free medical care, then fantastic. imho, it is a social duty for people 'who have' to share with people 'who do not.' however, it's not right for recipients of that care to expect them to do so, or for the government to force medical professionals to do so. what is right is for people to fulfill their obligation to pay for services rendered as agreed. if a woman can't afford to pay her mortgage and meet her healthcare payment obligations, then what's so wrong with her losing her house?! does she somehow have a right to own a home? (that was rhetorical, of course she doesn't...but maybe that's something about which we disagree?)

#5 as for the 'uninsurable' or the 'underinsured' in the system, well, that's a whole other ball of wax -- i'm more or less talking about uninsured adults here. case in point:

"I can GET insurance, we just can't afford the extra $250 a month."

umm. she has access to the internet, she has leisure time with which she could be working, she has the ability to read, write, and reason well enough to find a way to make it possible to earn/budget for the necessary $250/mo, it's just that she's made a decision that the coverage is not worth the sacrifice it would cost her. it's a risk she's taking, and one that she can afford to take because of the system of healthcare, emergency service, and government assistance available to people in the u.s.

the system indeed has problems, but the bias in your post is the problem i'm trying to address. i'm just asking you to re-consider your perspective prior to learning more or directing others' exploration into the topic. (i'd be happy to re-consider mine as well -- by all means if you feel i'm wrong, teach me so i can understand...)

here's a resource i like...
http://www.freemarketcure.com/whynotgovhc.php

and this one...
http://online.wsj.com/article/SB1222...ist_smartbrief

 

[mbravebird]

Quote:

Originally Posted by user_name if a doctor is willing to donate her time & expertise, or a clinic or hospital is set-up to provide free medical care, then fantastic. imho, it is a social duty for people 'who have' to share with people 'who do not.' however, it's not right for recipients of that care to expect them to do so, or for the government to force medical professionals to do so.

Do you feel this way about the services of firefighters, or police? Do you also believe, as most people in this country used to, that education should be a privilege only available to those who can afford it?

Quote:

Originally Posted by user_name what is right is for people to fulfill their obligation to pay for services rendered as agreed. if a woman can't afford to pay her mortgage and meet her healthcare payment obligations, then what's so wrong with her losing her house?! does she somehow have a right to own a home? (that was rhetorical, of course she doesn't...but maybe that's something about which we disagree?)

No, she doesn't have a "right" to own a home -- the injustice here is not the specifics of each situation, but that the insurance companies have so much more power than her in the "marketplace" that they can, within one short year of treatment, make her coverage unaffordable to her in order to save themselves money. That's free market, alright. The aim of private insurance is to weed out high-cost patients, and they do so very effectively. The balance of power is off when a sick person who could afford insurance before they got sick suddenly cannot afford it once they are sick, through no fault of their own, no change in their behavior other than they started using the health insurance they'd been paying for all these years. This isn't an issue of personal responsibility, it's an issue of the balance of power being off, and the market not fulfilling its purpose.

Quote:

Originally Posted by user_name it's a risk she's taking, and one that she can afford to take because of the system of healthcare, emergency service, and government assistance available to people in the u.s.

Do you realize the risk *you're* taking? If you're satisfied with the current system, then you're relying on odds that you won't yourself, or your children, won't need treatment that would make you a target of your insurance company, and make you unable to afford insurance, too. That's an awfully big risk to take. Especially for your children. Because if you make enough, your kids won't qualify for state insurance -- but if the treatment is expensive enough, you won't be able to afford the suddenly rising premiums and reduction of coverage. Are you really willing to put them in a position that precarious? Or maybe you think you have a plan for that already, although I don't see how. I know a family with a three-figure income and gold-plated insurance who were denied insurance for their four-year old within three years of his condition being diagnosed (he hit his lifetime cap, which the insurance company only instituted after they saw how much he was costing). They were told to divorce and set up separate households so that they could qualify their son for medical care. It could happen to you. It's an awfully big risk you're taking...

Quote:

Originally Posted by user_name the bias in your post is the problem i'm trying to address. i'm just asking you to re-consider your perspective prior to learning more or directing others' exploration into the topic. (i'd be happy to re-consider mine as well -- by all means if you feel i'm wrong, teach me so i can understand...)

I think the bias in your post is that you haven't really experienced the way the holes in the system can catch everyone, even the wealthy and the responsible. I know I'm being forceful here, but I really don't mean to be snarky. I hear the genuineness in your perspective, and I hope you hear it in mine. I know for a fact that the broken system can affect you, too -- and it sounds like you may not know that.

I'm not attached to any certain ideology about how to fix the situation, I'm just attached to fixing it. And what we've been doing has just been making it worse. My son's future, though, depends on us figuring out how to fix the system. So it's important to me that people know that it really is broken, and can and will affect everyone. Our eggs are all in the same basket here, just like with fire and police.

 

[Mamafreya]

Quote:

Originally Posted by mbravebird Do you feel this way about the services of firefighters, or police? Do you also believe, as most people in this country used to, that education should be a privilege only available to those who can afford it? No, she doesn't have a "right" to own a home -- the injustice here is not the specifics of each situation, but that the insurance companies have so much more power than her in the "marketplace" that they can, within one short year of treatment, make her coverage unaffordable to her in order to save themselves money. That's free market, alright. The aim of private insurance is to weed out high-cost patients, and they do so very effectively. The balance of power is off when a sick person who could afford insurance before they got sick suddenly cannot afford it once they are sick, through no fault of their own, no change in their behavior other than they started using the health insurance they'd been paying for all these years. This isn't an issue of personal responsibility, it's an issue of the balance of power being off, and the market not fulfilling its purpose. Do you realize the risk *you're* taking? If you're satisfied with the current system, then you're relying on odds that you won't yourself, or your children, won't need treatment that would make you a target of your insurance company, and make you unable to afford insurance, too. That's an awfully big risk to take. Especially for your children. Because if you make enough, your kids won't qualify for state insurance -- but if the treatment is expensive enough, you won't be able to afford the suddenly rising premiums and reduction of coverage. Are you really willing to put them in a position that precarious? Or maybe you think you have a plan for that already, although I don't see how. I know a family with a three-figure income and gold-plated insurance who were denied insurance for their four-year old within three years of his condition being diagnosed (he hit his lifetime cap, which the insurance company only instituted after they saw how much he was costing). They were told to divorce and set up separate households so that they could qualify their son for medical care. It could happen to you. It's an awfully big risk you're taking... I think the bias in your post is that you haven't really experienced the way the holes in the system can catch everyone, even the wealthy and the responsible. I know I'm being forceful here, but I really don't mean to be snarky. I hear the genuineness in your perspective, and I hope you hear it in mine. I know for a fact that the broken system can affect you, too -- and it sounds like you may not know that. I'm not attached to any certain ideology about how to fix the situation, I'm just attached to fixing it. And what we've been doing has just been making it worse. My son's future, though, depends on us figuring out how to fix the system. So it's important to me that people know that it really is broken, and can and will affect everyone. Our eggs are all in the same basket here, just like with fire and police.

ITA with this.

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